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Aging and the eye Masoud R. Manaviat, M.D. June 2011.

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Presentation on theme: "Aging and the eye Masoud R. Manaviat, M.D. June 2011."— Presentation transcript:


2 Aging and the eye Masoud R. Manaviat, M.D. June 2011

3 As people age, some physiologic changes are inevitable Other changes, while not universal, are far more common than among younger people Older people also face unique psycho-social challenges These changes and challenges can lead to a variety of geriatric syndromes and issues These in turn can lead to poor health outcomes, functional decline, frailty, disability and dependence The Challenges of Aging – How older patients are different from all other patients

4 Examples of universal changes Decreased night vision Decreased muscle mass Loss of hair pigment Decreased lung vital capacity Decreased height Decreased gait speed Physiologic Changes Associated with Aging

5 Examples of changes (including diseases) that are increasingly common, though not inevitable, as people age Hearing loss Macular degeneration Hypertension Heart disease Cancer Parkinsons disease Dementia Physiologic Changes Associated with Aging

6 Loss of income Loss of close family Loss of community Social isolation Social Problems More Common with Aging

7 Sensory Impairment (Visual and Hearing) Gait Impairment Falls Incontinence Dementia Depression Delirium Polypharmacy Sleep Problems Pressure Ulcers Geriatric Syndromes

8 In the 2000 US Census, 12.5% of the US population was >64 By 2030, it is predicted that 20% of the US population will be >64 As the elderly population increases the care needs and expenditures for that care will increase The geriatric workforce is not predicted to increase to meet this demand The Challenges of an Aging Population – Why it matters

9 Visual impairment affects 20-30% of people over the age of 75. Visual impairments that occur with greater frequency as people age include Refractive error Cataracts Glaucoma Macular degeneration Diabetic retinopathy Blindness Sensory Impairment - Vision

10 Age-Dependent Changes: Physiological and Performance

11 Aging Eye

12 Mostly affect appearance Seldom affect performance Some need monitoring with age Lens Aqueous Humor Retina Macula General Aging Changes

13 Sclera- thinner, pigment change Aqueous Humor- intraocular pressure Vitreous Humor- thins, opacity Cornea- arcus senilis (Ca and cholesterol), sensitivity Iris- muscles weaken, smaller pupil Lens size and thickness, elasticity Conjunctiva- dry eye General Aging Changes

14 Retina- dulls, blood vessel changes Optic Nerve- boundaries less defined, fewer capillaries Macula- little or no foveal reflex, drusen and lipofuscin deposits, pigmentation Lids- orbicularis oculi muscle weakens Lacrimal Glands/Tears- production, Orbit- fat loss, enophthalmos More General Aging Changes!

15 Refraction- lens and ciliary muscles Results in Presbyopia Age 40+ Acuity and Contrast Decreases after age 50 Due to Brain Glare Due to lens and vitreous humor Dark Pupil and Lens Age Changes in Performance

16 Fun stuff- Vitreous Humor? Haziness Flashing Lights Moving Spots Color Discrimination as cones Dark Pupil and Lens Visual Field Size 1 to 3 degrees per decade More Performance Changes!

17 Age-Related Changes: Diseases and Syndromes

18 Normal Dry AMD Wet AMD


20 Symptoms: increase in lens opacity Peripheral to nuclear Causes/Risk Factors: UV light/free radicals Glycation Corticosteroids Diabetes Cataracts


22 What is it? Clouding of the eyes lens that causes loss of vision. Cataract

23 Who is at higher risk? Most cataract are related to aging Other risk factors Diabetes Smoking Exposure to sunlight (continued from previous slide)

24 Cataract Same scene as viewed by a person with cataract Normal vision

25 Symptoms Cloudy or blurred vision. Colors that may not appear as bright as they once did. Glare. Poor night vision. Cataract

26 Treatment options Glasses Better lighting Surgery (continued from previous slide)

27 What can you do? Eat a healthy diet. Wear sunglasses and a brimmed hat when outdoors. Dont smoke. Cataract

28 Glaucoma

29 What is it? A group of eye diseases that can damage the optic nerve in the eye. Glaucoma can develop in one or both eyes. Primary open-angle glaucoma is the most common form. Glaucoma

30 Who is at higher risk? African Americans over age 40. Everyone over the age of 60, especially Mexican Americans. People with a family history of glaucoma. (continued from previous slide)

31 Glaucoma Same scene as viewed by a person with glaucoma Normal vision

32 Symptoms No early warning signs or symptoms No pain Loss of side vision Treatment options Medications, usually eye drops Laser or conventional surgery Glaucoma

33 What can you do? People at higher risk should get a comprehensive dilated eye exam every one to two years or as instructed by your eye care professional. Glaucoma

34 Macular Degeneration

35 What is it? Common among people aged 60 or older. Can damage the macula, which is needed for sharp, detailed central vision. Age-Related Macular Degeneration (AMD)

36 Who is at higher risk? The greatest risk factor is age. Other risk factors Smoking. Family history. Obesity. Race. Caucasians are more likely to lose vision from AMD. (continued from previous slide)

37 Age-Related Macular Degeneration (AMD) Same scene as viewed by a person with AMD Normal vision

38 Symptoms No pain. Blurred vision. Drusen (can only be seen by an eye care professional). AMD

39 Treatment options Age-Related Eye Disease Study (AREDS) special vitamins/minerals supplement formulation. Laser surgery. Eye injections. Photodynamic therapy. (continued from previous slide)

40 What can you do? Eat a healthy diet Dont smoke, or stop smoking Maintain normal blood pressure Maintain a healthy weight Exercise AMD

41 Diabetic Retinopthy

42 What is it? A group of eye problems associated with diabetes. Diabetic retinopathy is a leading cause of vision loss and blindness. Diabetic Eye Disease

43 Who is at higher risk? People with diabetes. The longer someone has diabetes, the more likely it is he or she will get diabetic retinopathy. (continued from previous slide)

44 Diabetic Retinopathy Same scene as viewed by a person with diabetic retinopathy Normal vision

45 Symptoms No early warning signs or symptoms Early detection and timely treatment can reduce the risk of vision loss. Treatment options Laser treatment Surgery Diabetic Eye Disease

46 What can you do? Control your ABCs - A1C, blood pressure, and cholesterol. Take your medications as directed. Maintain a healthy weight. Exercise. Dont smoke. Have a dilated eye exam at least once a year. Diabetic Eye Disease

47 What is it? The eye does not produce tears properly. Tears evaporate too quickly. Inflammation of the surface of the eye may occur along with dry eye. Dry Eye

48 Who is at higher risk? Women often experience dry eye more than men. Dry eye can occur at any age. Older adults frequently experience dryness of the eyes. (continued from previous slide)

49 Symptoms Stinging or burning of the eye. Feeling as if sand or grit is in the eye. Episodes of excess tears following dry eye periods. A stringy discharge from the eye. Pain and redness of the eye. Episodes of blurred vision. Dry Eye

50 Symptoms Heavy eyelids. Decreased tearing or inability to shed tears when crying. Uncomfortable contact lenses. Decreased tolerance to any activity that requires prolonged visual attention. Eye fatigue. (continued from previous slide)

51 Treatment options Using artificial tears, prescription eye drops, gels, gel inserts, and ointments. Wearing glasses or sunglasses. Getting punctal plugs. (continued from previous slide)

52 What can you do? Use an air cleaner to filter dust Avoid dry conditions Use lubricating eye drops Visit an eye care professional Dry Eye

53 Low Vision Aids


55 What is it? A visual impairment that is not corrected by standard eyeglasses, contact lenses, medication, or surgery. It interferes with the ability to perform everyday activities. Low Vision

56 Who is at higher risk? People with eye disease. Some people develop vision loss after eye injuries or from birth defects. (continued from previous slide)

57 Treatment options Vision rehabilitation. What can you do? See a specialist in low vision. Talk to your eye care professional about vision rehabilitation. Use low vision devices. Low Vision


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